TASK DEFINITION: Given a context passage, generate a question from the passage such that its answer is shortest continous span from the passage.
PROBLEM: Urgent surgery or life-threatening bleeding requires prompt reversal of the anticoagulant effects of dabigatran. This study assessed the ability of three- and four-factor prothrombin complex concentrate (PCC) and idarucizumab (specific antidote for dabigatran) to reverse the anticoagulant effects of dabigatran in a porcine model of trauma. Twelve animals were given dabigatran etexilate (DE) orally and dabigatran intravenously, before infliction of trauma. Six animals received tranexamic acid plus fibrinogen concentrate 12 minutes post-injury. Six PCCs (each 30 and 60 U/kg) and idarucizumab (30 and 60 mg/kg) were added to blood samples ex vivo. Coagulation was assessed by several coagulation assays. All coagulation parameters were altered after dabigatran infusion (plasma level: 442 138 ng/ml). Both three- and four-factor PCCs mostly or completely reversed the effects of dabigatran on thromboelastometry variables and PT but not on aPTT. Idarucizumab neutralised plasma concentrations of dabigatran, and reversed the effects of the drug on coagulation variables. Thrombin generation showed dose-dependent over-correction following the addition of PCC, implying that elevated levels of thrombin are required to overcome dabigatran-induced coagulopathy. In contrast, treatment with idarucizumab returned thrombin generation to baseline levels. Following trauma, therapy with tranexamic acid plus fibrinogen improved correction of coagulation parameters by PCC, and thromboelastometry parameters by idarucizumab. All investigated PCCs improved dabigatran- and trauma-induced coagulopathy to a similar degree. In conclusion, this study shows that three- and four-factor PCCs are similarly effective for dabigatran reversal. Idarucizumab also reversed the effects of dabigatran and, unlike PCCs, was not associated with over-correction of thrombin generation.

SOLUTION: Which drug can be reversed with idarucizumab?

PROBLEM: Like water and carbon, nitrogen is also repeatedly recycled through the biosphere. This process is called the nitrogen cycle. Nitrogen is one of the most common elements in living organisms. It is important for creating both proteins and nucleic acids, like DNA. The air that we breathe is mostly nitrogen gas (N2 ), but, unfortunately, animals and plants cannot use the nitrogen when it is a gas. In fact, plants often die from a lack of nitrogen even through they are surrounded by plenty of nitrogen gas. Nitrogen gas (N2 ) has two nitrogen atoms connected by a very strong triple bond. Most plants and animals cannot use the nitrogen in nitrogen gas because they cannot break that triple bond. In order for plants to make use of nitrogen, it must be transformed into molecules they can use. This can be accomplished several different ways ( Figure 1.1). Lightning: When lightening strikes, nitrogen gas is transformed into nitrate (NO3 ) that plants can use. Nitrogen fixation: Special nitrogen-fixing bacteria can also transform nitrogen gas into useful forms. These bacteria live in the roots of plants in the pea family. They turn the nitrogen gas into ammonium (NH4 + ) (a process called ammonification). In water environments, bacteria in the water can also fix nitrogen gas into ammonium. Ammonium can be used by aquatic plants as a source of nitrogen. Nitrogen also is released to the environment by decaying organisms or decaying wastes. These wastes release nitrogen in the form of ammonium. Ammonium in the soil can be turned into nitrate by a two-step process completed by two different types of bacteria. In the form of nitrate, nitrogen can be used by plants through the process of assimilation. It is then passed along to animals when they eat the plants. Turning nitrate back into nitrogen gas, the process of denitrification, happens through the work of denitrifying bacteria. These bacteria often live in swamps and lakes. They take in the nitrate and release it back to the atmosphere as nitrogen gas. Just like the carbon cycle, human activities impact the nitrogen cycle. These human activities include the burning of fossil fuels, which release nitrogen oxide gasses into the atmosphere. Releasing nitrogen oxide back into the atmosphere leads to problems like acid rain.

SOLUTION: the initial step of producing a nitrogen containing compound from nitrogen in the soil is

PROBLEM: U.K ambulance services assess patients with suspected stroke using the Face Arm Speech Test (FAST). The Recognition Of Stroke In the Emergency Room (ROSIER) tool has been shown superior to the FAST in identifying strokes in emergency departments but has not previously been tested in the ambulance setting. We investigated whether ROSIER use by ambulance clinicians can improve stroke recognition. Ambulance clinicians used the ROSIER in place of the FAST to assess patients with suspected stroke. As the ROSIER includes all FAST elements, we calculated a FAST score from the ROSIER to enable comparisons between the two tools. Ambulance clinicians' provisional stroke diagnoses using the ROSIER and calculated FAST were compared with stroke consultants' diagnosis. We used stepwise logistic regression to compare the contribution of individual ROSIER and FAST items and patient demographics to the prediction of consultants' diagnoses. Sixty-four percent of strokes and 78% of nonstrokes identified by ambulance clinicians using the ROSIER were subsequently confirmed by a stroke consultant. There was no difference in the proportion of strokes correctly detected by the ROSIER or FAST with both displaying excellent levels of sensitivity. The ROSIER detected marginally more nonstroke cases than the FAST, but both demonstrated poor specificity. Facial weakness, arm weakness, seizure activity, age, and sex predicted consultants' diagnosis of stroke. The ROSIER was not better than the FAST for prehospital recognition of stroke. A revised version of the FAST incorporating assessment of seizure activity may improve stroke identification and decision making by ambulance clinicians.

SOLUTION:
ROSIER scale is used for which disorder?

